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Internuclear Ophthalmoplegia in Childhood Shirley H. Wray, M.D., Ph.D. Professor of Neurology, Harvard Medical School Director, Unit for Neurovisual Disorders.

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Presentation on theme: "Internuclear Ophthalmoplegia in Childhood Shirley H. Wray, M.D., Ph.D. Professor of Neurology, Harvard Medical School Director, Unit for Neurovisual Disorders."— Presentation transcript:

1 Internuclear Ophthalmoplegia in Childhood Shirley H. Wray, M.D., Ph.D. Professor of Neurology, Harvard Medical School Director, Unit for Neurovisual Disorders Massachusetts General Hospital

2 Figure 1A: Primary gaze.

3 B: Gaze Right. Left internuclear ophthalmoplegia

4 C: Gaze left. Right internuclear ophthalmoplegia.

5 Figure 2: Pneumoencephalography: blockage of the aqueduct.

6 Figure 3: Pneumoencephalography: obstructive hydrocephalus. Enlarged ventricles.

7 Figure 4: Enlarged ventricles, obstructive hydrocephalus.

8 Figure 5: Histological section: Medulloblastoma.

9 Bilateral Internuclear Ophthalmoplegia in Children A manifestation of Brain Stem Tumor 6 cases – 3 boys, 3 girls Ages 4.5, 7.5, 9.5, 10, 16, and 17 years Duration of symptoms: 9 mos. – 6 years (4/6 dead) Other Symptoms: Headache4 Papilledema1 Clumsiness4 Pathology Medulloblastoma1 Medulloblastoma or Glioma2 Infiltrating Glioma1 Cogan DG, Wray SH. Neurology. 1970. 20: 629 – 633.

10 References Cogan DG, Kubik CS, Smith JL. Unilateral internuclear ophthalmoplegia: report of 8 clinical cases with 1 post-mortem study. Arch Ophthalmol 1950; 44:783-796. Cogan DG, Wray SH. Internuclear ophthalmoplegia as an early sign of brainstem tumor. Neurology 1970; 20:629- 633.

11 Cogan DG. Internuclear opthalmoplegia typical and atypical. Arch Ophthalmol 1970; 84:583-589. Keane JR. Internuclear ophthalmoplegia: unusual causes in 114 of 410 patients. Arch Neurol. 2005 May; 62(5):714-7.

12 http:// www.library.med.utah.edu/NOVEL

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